Where Therapy and Mindfulness Clash

Photo by Hermes Rivera

There are particular challenges in being a therapist first and mindfulness teacher second. Our conditioning as helping professionals can place us at odds with the original intent behind mindfulness practice. The longer we have been treating people, the harder it can be to transcend our original training so that we can embody these radically different teachings.

Therapists and therapy clients alike might easily confuse the goal of mindfulness practice with the goals of psychotherapy. Much of psychotherapy is aimed at strengthening the self and making behavior more adaptive to one’s environment. So, much of what we do with clients serves the ego: building self-esteem, pursuing self-actualization, understanding oneself, becoming more authentic, finding one’s voice, reaching one’s potential, being successful in the world, fulfilling desires (wishes, dreams and passions), optimizing performance and functioning. These aren’t bad things in and of themselves – they often bring clients some relief and a reduction in painful symptoms. Some clients are barely surviving and they desperately need some solid ground to stand on.

The goal of mindfulness practice; however, is ultimate liberation from suffering, which requires decentering from self and notions of conventional reality. According to C. W. Huntington in his insightful article on this topic in Tricycle Magazine, “Buddhist teachings remind us that we will never achieve real or lasting satisfaction by adopting a different, better way of thinking or acting.” He says mindfulness practice is “the primary means for stepping away from the whole project of searching for happiness by judging and choosing, rejecting some things while accepting others.”

Insight meditation does not involve analyzing the content of thoughts or finding the reason behind a particular emotion or body sensation, it involves simply observing one’s experience. Therapists who teach mindfulness (myself included) can easily drift into what I call “shrinksplaining”. Instead of allowing clients to have their experience, we lay it all out there for them. We wrap it up in a neat package. This is often prompted by our clients themselves, who can be extremely uncomfortable with ambiguity. So, being helpers, we want to help them understand and feel more comfortable. We have tools and strategies that we have been trained to administer to decrease discomfort – we are not accustomed to helping clients be with their discomfort.

Many of us also hold a number of fundamental beliefs that can, when taken too far or held too rigidly, undermine our effectiveness as mindfulness teachers:

Something is Wrong

The notion of pathology is that a person is suffering from a disease. The practice of medicine assumes that the patient has something wrong with them that needs to be put right. This is also true in psychology – there is an illness that must be managed. All of this is reinforced by the insurance industry that reimburses for “medically necessary” interventions. So, therapists have been trained to treat clients much like a doctor treats a patient and we don’t feel like we’re doing a good job unless a disease is being cured.

In mindfulness, everything is fodder. There is no right or wrong experience – just actual experience. As Jon Kabat-Zinn famously wrote, “As long as you are breathing, there is more right with you than there is wrong.” In practicing mindfulness, we learn to trust experience to be the guide and we discover our shared humanity in the process. In addition, the mindfulness teacher is not a treatment provider – rather teacher and participant practice together on a shared journey of discovery.

The Doctor Provides the Cure

In psychotherapy and in medicine, there is a strong pull for the therapist to feel responsible for the client/patient. In this age of accountability, providers compensation may depend upon patient outcomes. Even in private practice, the people who come to see us are customers who are looking for results. In some cases, a provider might be sued for what a patient/client does or fails to do. This can create a paternalistic or overly transactional dynamic which is unrealistic, fear-based, and undermining of autonomy. Although it is important for us to have standards of care, an over-focus on provider responsibility fails to acknowledge that there is a path that must unfold in its own time and in its own way. It can’t be manufactured or rushed.

Mindfulness practices can be an incredibly healing adjunct to traditional approaches. The research is revealing just how helpful this perspective can be for people who are experiencing a variety of difficulties. For example, Mindfulness Based Programs (MBPs) are evidence based mind-body programs that train participants in the cultivation of mindfulness in order to support wellbeing, address the causes of human distress, and offer pathways to relieving suffering. However, providers must be sensitive to our own habits and biases. We must be skillful in the way we relate these practices to others. First and foremost, we must have an established personal mindfulness practice so we can embody what we teach and relate the teachings in a way that is truly beneficial.

“We are so seduced by thinking and emotion and we don’t realize that awareness is at least as powerful of a function. It can hold any emotion, no matter how destructive, any thought, no matter how gigantic. That’s where the transformative power lies… Mindfulness represents a new way of being in relationship with yourself, one that’s catalytic of a new way of ongoing learning and healing. The transformation comes with the understanding that you are not your thoughts about yourself. You are far far bigger, more nuanced and multidimensional than who you think you are, the story of you. In some sense, it’s befriending yourself.” – Jon Kabat-Zinn